Healthy Life!
How do we want to feel throughout our lifetime? Health and mobility are at the top of my list. For me it boils down to taking care of myself.
Balance, Falls and Resilience
Falls can happen in an instant. They are one of the top fears for older adults. The statistics are frightening. Between the years 2000-2016 the rate of mortality from falls for those over age 75 more than doubled.(1)
Weakness when standing, insecure balance, and falling are leading cause of fatal and non-fatal injuries for older Americans.(2) Standing and walking balance is taken for granted for a large portion of our lives. When adults start talking about balance, it is usually when they begin to notice their balance declining. By then, they may have already reduced activity, and may have even resigned themselves to being forever unbalanced and at a risk of a fall. Most older adults know that if they fall and become injured, the outcome could have dire circumstances. Who wants to live like that?
With all the negative information out there, no wonder there is so much fear around loss of balance and falling. National surveys show that only 1 in 3 people get advice on physical fitness or exercise from their medical doctor. Racial, ethnic minorities and the elderly get this advice even less. Most advice surrounding exercise given by doctors has historically been centered around cardiovascular health and aerobic exercise. “Get out and walk!” they are told. Not always is this a practical solution for those who are unsteady and feel fearful being out of the home at risk of a fall. The risk outweighs the reward.
Physicians and physical therapists need more resources and avenues for senior adults to access when they need to improve their balance and reduce their fall risk. Evidence-based fall prevention programs are fortunately on the rise in retirement communities, senior centers, and general recreation and fitness facilities. These programs are valuable but do not begin to serve the needs of the expanding geriatric demographic. More qualified fitness professionals as well as more accessible and affordable programs are needed to help serve this growing need to keep our aging seniors upright and steady on their feet! Fall resistance and resilience training will change these statistics.
It is safe and realistic to say that there are 2 categories of older human beings in relation to balance: the “fallen” and the “not-yet fallen”
Often a trainer will acquire a client that has already fallen and is fearful. The client must first work to overcome this intense fear and the hesitancy of movement that this fear creates. The importance of using E3 (Educate, encourage, and empower) cannot be underestimated here. It is important that geriatric fitness trainers have a deep understanding of the basic principles surrounding the science of balance as well as training methods that are best for reducing fall risk for both categories. Getting the “already fallen” to rise up and move with confidence again will require systematic and progressive programming combined with patient and compassionate instruction.
Fall Resiliency for the “Already Fallen”
Each year millions of older adults suffer falls. Many of these result in serious physical injuries that can reduce their mobility and functioning, cause pain and discomfort, and even increase the likelihood of death in the near future. It is not only the physical effects of the fall that you should consider. Once the injuries have healed and general function is restored, they may be experiencing serious emotional consequences in the form of fearfulness which can diminish their quality of life as they age in place. Helping them to handle this type of impact can help them to move forward after their fall and preserve their lifestyle.
A 2012 university study found that loss of mobility might be due, in part, to “balance confidence”, an issue closely related to a fear of falling. The study concluded that among people who have had a fall-related hip fracture, an independent relationship exists between balance confidence and mobility and balance performance – as well as perceived mobility function.
The study tracked 130 adults over the age of 60 who had suffered hip fractures between six weeks and 7.4 years prior to observation. To test balance confidence, researchers used a simple but comprehensive measure called the Activities-specific Balance Confidence Scale (ABC Scale).(4) The ABC scale can be self-administered, and is comprised of a series of questions that gauge an adult’s confidence in various walking scenarios, such as walking up steps or on an icy path. Adults who rated a higher balance confidence tended to do better in balance and mobility tests.
Use these tips to help someone recover from the emotional impact of a fall:
Acknowledge it. An older adult may feel as though their emotional response to their fall is overly dramatic or not a big deal, and cause them to not discuss it, which can worsen the negative impact. Acknowledge that they have gone through something frightening and humbling. Show them that you can offer support and encouragement as they overcome the fear and movement hesitancy the often comes after a fall.
Recognize the risk. Suffering from one fall does increase the chances that your senior will suffer from another fall. Recognizing this risk and acknowledging this fact is important because it both validates the fear they may now have, and it may foster difficult decisions surrounding their safety in the future. Keeping open communication surrounding this serious issue will allow for prudent decisions regarding their living situation.
Encourage them. The emotional impact of falling can range from simple embarrassment to worry and distress about the changes in their physical functioning, which creates the fear that they will fall again. It does not mean that they should just stop engaging in activity which could actually further diminish their quality of life and increase the possibility of another fall. Introducing movement and exercise in incremental steps and stages will rebuild their confidence, but must be done at their pace. Praise all progress.
Imbalance is not entirely a result of muscle weakness. Strengthening muscles alone will not improve balance. Balance will improve when it is practiced in everyday activities and keen body awareness. Imbalance begets inactivity and inactivity accelerates the aging process.
Balance cannot be willed by the mind. We are not born with balance. We learn balance developmentally as we grow from babies to adults. The body learns how to stay erect in the face of gravity and the forces that are put upon it. It retains balance by staying active. Inactivity erodes balance which in turn inhibits people from being active. A vicious cycle that needs intervention and solutions.
Retraining balance and fall resistance requires knowledge of the anatomy and physiology involved in balance. The muscle systems of the body belong to one of two categories. The Phasic muscles are the mobilizing and movement/action muscles. The mind tells these the body to move in a certain way and the joints move from the contracting and elongation of these mostly fast-twitch muscles. The second type are the Postural or balance muscles and are not subject to conscious direction. These are slow-twitch stabilizing muscles and they engage automatically to hold a person erect against gravity’s pull. They do not shorten or lengthen, but supply isometric tension. With underuse, these postural muscles can “forget” how to maintain balance even on steady and level surfaces. Falling and hesitant walking is the sign that a lifetime of balance muscle memory is declining or lost. Without retraining our postural muscles, imbalance will take over. The solution is to re-educate and activate these essential postural/balance muscles in concert with the Phasic (movement/action) muscles (3) Trainers must encourage daily balance practices and educate their clients on how to manage their posture and center of gravity through drills and skills that align with their functional and independence needs.
Fit Pros: Work with Older Clients on Fall Prevention (and MORE!) as a Geriatric Fitness and Lifestyle Specialist
Millions of people over age 65 looking for guidance from fitness professionals who are knowledgeable in exercise, nutrition and lifestyle principles that can help them improve functional mobility, while also preventing and managing chronic conditions to live their highest quality of life. The Geriatric Fitness and Lifestyle Specialist online certificate course will give you insights, strategies and tools to be a successful professional in this rapidly growing market. Learn how to be a valued part of clients’ continuum of care, working with the medical team to improve functional outcomes and positively impact people’s lives.
Holly H. Benson, BS, is a veteran in the Recreation and Fitness industries with over 35 years of administrative and technical experience. She holds two bachelor’s degrees, Corporate & Community Fitness and Recreation Administration, and numerous fitness certifications. She has developed thriving fitness programs for special populations and has passionately focused her career on the much older adult. She currently owns and operates Moving Strong Medical Exercise, LLC in Lakewood, Colorado and provides in-home and virtual fitness training to older adults and persons with chronic medical and orthopedic conditions.
References
September 18-22 is Falls Prevention Awareness Week!
One in four Americans over age 65 falls every year. Falls are the leading cause of both fatal and non-fatal injuries for seniors. Through practical lifestyle adjustments, evidence-based programs, and community partnerships, the number of falls among the aging population can be reduced!
September 18-22 is the National Council on Aging’s Falls Prevention Awareness Week. Visit the NCOA website for more Falls Prevention Toolkit, filled with resources for both the public and fitness professionals!
Video: 6 Steps to Prevent a Fall
Video courtesy of National Council on Aging.
Where to Begin When You Are Working Out With a Health Condition
The gym can be a confusing place especially for individuals with health concerns. Many times, these clients are trying to navigate their workouts by themselves because they are unsure of the appropriate questions that they need to ask.
First of all, there are two different types of trainers. There are trainers who have a four year degree and certifications. These trainers are sometimes called Fitness Specialists and have had many hours of study related to a wide variety of diseases and injuries. They are used to modifying exercises and programs based on any specific condition you may have. Fitness Specialists are usually found in a medically based fitness facility affiliated with a hospital. Please note that some Fitness Specialists will specialize in a certain area. Some work with individuals with diseases and disabilities and some don’t. You can search the free MedFit Network directory to find a fitness pro in your area. In their MFN profile, you’ll find information about their condition-specific education and services.
When you finally narrow down who you might like to hire you will want to ask some questions. Please don’t be afraid to ask these questions as they will help you to decide which trainer is right for you. It is also recommended that you observe Fitness Specialists training clients.
First you want to make sure that the trainer has had experience with your condition. If not, they should be willing to research it and or speak with your doctor with your permission. There are exercise guidelines that all Fitness Specialists should follow when working with clients who have health conditions.
You will also want to ask about the trainers background. It is alright to ask about education, certifications, and years of experience. You also want to hire someone who is patient with you. This is extremely important as you figure out which exercises work best for your body. I would also like to add that you need to be patient with yourself as well. Try to relax and enjoy your training session.
Asking the questions from above help to keep you feeling confident. Exercise can seem frustrating in the beginning but you have to keep a positive mindset. In the beginning, set small goals and do the best you can during each training session.
Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.
Fitness and Multiple Sclerosis: Overcoming Challenges to Embrace a Healthy Lifestyle
Living with multiple sclerosis (MS) can pose numerous challenges, but maintaining a regular fitness routine is essential for enhancing overall well-being and managing symptoms effectively. Exercise can improve muscle strength, balance, flexibility, and cardiovascular health while boosting mood and reducing fatigue. In this article, I will explore the benefits of implementing an exercise program with specific training methods for individuals with multiple sclerosis, types of exercises that are beneficial, safety considerations, and tips for incorporating fitness into the daily routine of an MS client.
Back to Basics
As health and fitness professionals we like to think of ourselves invincible. After all, we help people feel better, and accordingly, we should never do anything to appear less than indomitable. We also all know this is simply not true.
The Nutrition Debate: Enough is NEVER Enough
A recent issue of the Annals of Internal Medicine tried to put a nail in the coffin of nutritional supplements. “Unregulated, not safe, harmful, and no benefits” shouted the authors of the Letter to the Editor of the journal. Yet another attempt by physicians and the pharmaceutical industry to put a damper on the use and sale of vitamins and minerals.
Keys to Empowering Women in the Weight Room, Part 2
In Part 1, I reviewed the ACSM study goals, statistics and barriers to weightlifting unique to women
In this article, I’ll cover the three E’s for empowering women in the weight room, and translate these recommendations into strategies that non-professionals can implement for themselves.
1. ENVIRONMENT
Understanding how physical attributes of gyms perpetuate negative messaging regarding women’s bodies and harmful myths about women’s fitness.
- Body image as the sole motivator for exercise with full-length mirrors and posters presenting unrealistic expectations for women’s bodies.
- Insufficient equipment and scaling options.
- An overwhelming male presence and masculine perceptions that can complicate women’s relationship with the gym environment and diminish their confidence to participate.
Overcoming these barriers:
- When considering an environment that is the best fit for you, avoid those spaces with attributes that make you feel uncomfortable. You may prefer a gym with more limited mirror space, and that has a more balanced male/female demographic and female trainers. An example of a more supportive environment is a typical CrossFit “box” where the male-to-female demographic is often split and you will rarely find a mirror.
- Consider a female-only gym space.
- Consider group weightlifting classes. As a former BodyPump instructor, I can vouch for this program as a fantastic way for any beginner to gain confidence with weights and develop a base of sound movement patterns.
- One-on-one training is an excellent way to get personalized instruction on safe weightlifting technique and individualized goal-setting to gain confidence in the basics of weightlifting.
2. EXPERIENCE
People will often gravitate toward their comfort zones and do exercise routines that are more familiar and that are easy to execute.
- Unrealistic expectations for results and timelines to achieve them.
- “Weightlifting is hard.
- Fear of injury or “being sore”.
- “I don’t want to exercise by myself.”
- “I don’t have time to lift weights.”
Overcoming these barriers:
- Focusing on realistic goals of improvements in strength, movement quality, well-being, and specifically for mid-life women, maintenance of bone density and muscle mass to prevent fractures and maintain a healthy metabolism and glucose control.
- Working with a Coach or Trainer to create a personalized program design and dispelling the misconceptions that one needs to spend many hours per week and be sore after every workout to achieve benefits.
- Effective workouts can be achieved in as little as 10-20 minutes provided that the sets, repetitions, and rest periods are programmed accordingly.
- Seek out gym environments that promote small-group weightlifting classes and allow members to bring a guest.
3. EDUCATION
Knowledge is power. Promoting an understanding of the principles of weightlifting and its benefits is key to debunking myths and misconceptions and building a healthy relationship with the barbell.
Common myths and misconceptions about weightlifting:
- Resistance training is less beneficial than cardiovascular exercise.
- Weight training is “dangerous” for women.
- I need to spend hours in the gym to see any benefits.
- Resistance training is not optimal for fat burning.
Overcoming these barriers:
- Seek out opportunities to work one-on-one with experienced trainers who have experience with resistance training in female clients of all ages.
- Take a personal “inventory” of what is most important for you to feel comfortable incorporating weight training into your fitness program and your specific goals. Do you prefer one-on-one instruction? Do you prefer a women-only environment? Is a group setting important to you? Do you have injuries or physical limitations that need to be considered?
- Advocate for yourself. Once you have an idea of what is important for you to succeed, don’t be afraid to ask questions when visiting a facility.
- Do your homework. Read reviews of a facility before you join. Talk to other members. Review the credentials and experiences of the Coaches who work at the facility.
- Seek out reliable sources of information about the benefits of weight training for women as well as safe and effective approaches to the barbell for any level of experience. Here are some of my go-to’s for reliable information:
- MedFit – Menopause Health and Fitness Specialist Course – a 13-hour course focusing on the female experience with the menopause transition, the unique physiology of this life stage and practical application of nutrition and fitness strategies specific to the needs of this population. Fit Pros can earn CEU credit with NASM, ISSA, and canfitpro.
- Dr. Stacy T Sims – blog
- Next Level – by Stacy Sims and Selene Yeager
- CrossFit.com
- Hit Play Not Pause Podcast
- Les Mills BodyPump
- .. and don’t forget the Athletic Aging Monday morning weekly workout series where you will find a treasure trove of resistance training workouts you can do at home (or in the gym) with minimal equipment and modifications for any fitness level.
This is the time of our lives when we need to kick the societal status quo to the curb and take our health and wellness into our own hands and away from destructive narratives. The world is our oyster. We have established our careers, raised our children, and had our share of triumphs and failures. With that comes the wisdom to pave our own way into this new prime of our lives.
So, whether it’s your first back squat with a PVC pipe or a deadlift PR (personal record), congratulations on forging a new frontier to being your fittest, strongest, most vital self!
Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School. She is a North American Meno
Fit Pros: Offer menopausal and perimenopausal women an individualized approach to training, nutrition and wellness as a Menopause Health and Fitness Specialist.
References
- Ford, C, Kercher VM, Kercher KA; The 3 E’s – Keys to Empowering Women in the Weight Room. ACSM’s Health & Fitness Journal 27(3):p 14-19, 5/6 2023.
- Harne AJ and Bixby WR. The benefits of and barriers to resistance training among college-age women. Journal of Sport Behavior 19(2):151-66, 2005
Keys to Empowering Women in the Weight Room, Part 1
The hormonal changes of mid-life bring our muscle and bone mass under assault. As circulating estrogen declines and estrogen receptors in skeletal muscle become scarcer, changes in bone density, muscle mass, and metabolism become apparent.
Shoulder to shoulder with the importance of cardiovascular health, optimizing our muscle and bone health helps stave off decline in bone density which can lead to fracture, and can help mitigate the increasing insulin resistance that wreaks havoc on our changing metabolism.
To coin a phrase from Dr. Stacy Sims, there is a great benefit to women in this stage of life (and all stages of life) who “Lift heavy sh*t”. Now, if you have never lifted weights, this can sound intimidating. But don’t worry. You are not alone.
Historically, there have been many barriers to women in the weight room. Training environments where achieving a certain body image is the focus rather than building strength, healthy movement patterns, and improving body composition can be unmotivating and intimidating. The stigma of weightlifting as “masculine” or that it “makes you bulky” and the misconceptions that weightlifting is not beneficial for women are also among the many obstacles that women of all ages face.
In the May/June issue of ACSM Health and Fitness Journal, Claire Ford et al. do an excellent job of defining the obstacles that women face in the weight room and have created a framework called “The 3 E’s” that outlines strategies to overcome these barriers. I’ll take the summary points from this article and translate them into practical solutions for women and fitness professionals to empower themselves in the world of weightlifting.
The 3 E’s – Keys to Empowering Women in the Weight Room
Ford, C, Kercher VM, Kercher KA; ACSM’s Health & Fitness Journal 27(3):p 14-19, 5/6 2023.
Goal of the study
Use a socioecological model to provide insight into the nature of women’s unique experiences with weightlifting and describe a practical approach for empowering women in this environment.
Some statistics
Just 2 days per week of resistance training can reap physical, mental, and emotional health benefits.
Only 25% of the US population meets these recommendations.
17.5% of women engage in weightlifting on a regular basis
Benefits of Weightlifting
- Improves body composition.
- Helps prevent bone loss.
- Maintenance of healthy metabolism.
- Maintenance of quality movements over the lifespan.
- Promotes emotional well-being and self-concept.
Barriers to weightlifting unique to women
The notion that women face unique barriers to weightlifting has been a subject of investigation. Harne and Bixby organized these barriers into the following 3 categories:
Time / effort
- “I don’t want to get bulky”.
- ”I’m afraid I’ll hurt myself”.
- “I don’t want to be sore”.
- “I’m in terrible shape”.
Physical Effect
- “I don’t have time to lift weights”
- “It’s too hard”
- “It’s easier to hop on the treadmill”
- “I’m overwhelmed at the gym
Social
- “I don’t have anyone to go to the gym with”
- “Isn’t weightlifting better for men?”
- “I like the group classes because my friends can come with me”
- “There are too many men. I feel like I don’t belong”
The 3 E’s: A framework through which we can understand and address women’s barriers to weightlifting
After identifying and categorizing these unique barriers to weightlifting that women face, the authors created a framework upon which to overcome these barriers. This framework is called “The 3 E’s”.
This ACSM article speaks to an audience of fitness professionals and how the fitness industry can work to overcome these barriers.
In Part 2 of this article, I take this a step further and translate these recommendations for fitness professionals into strategies that non-professionals can implement for themselves.
Fit Pros: Offer menopausal and perimenopausal women an individualized approach to training, nutrition and wellness as a Menopause Health and Fitness Specialist.
Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner and has been featured in multiple podcasts and speakerships at various events discussing the physiology of the hormonal changes of menopause, hormone therapy and functional fitness training.
References
- Ford, C, Kercher VM, Kercher KA; The 3 E’s – Keys to Empowering Women in the Weight Room. ACSM’s Health & Fitness Journal 27(3):p 14-19, 5/6 2023.
- Harne AJ and Bixby WR. The benefits of and barriers to resistance training among college-age women. Journal of Sport Behavior 19(2):151-66, 2005